Study On Difference Of Clinical Characteristics In Intussusception Secondary To Different Pathological Lead Points And Its Ultrasonic Diagnostic Vale

Objective:To analyze the difference of clinical characteristics between secondary intussusception and idiopathic intussusception,and among intussusception secondary to different pathological lead points(PLP)in children,to evaluate the diagnostic efficacy of ultrasonography in intussusception secondary to focal PLP and to explore its sonographic features.Methods:1.The clinical data of children with intussusception were collected and divided into secondary intussusception group and idiopathic intussusception group according to whether there was PLP or not.The differences of clinical characteristics between the two groups were analyzed.2.Five main PLP were selected according to the pathological classification.The differences of clinical characteristics in children with secondary intussusception due to them were analyzed.3.The children with focal PLP secondary intussusception were taken as the case group and the children with idiopathic intussusception after surgical reduction as the control group.The differences of ultrasonic data between the two groups were analyzed.The positive results of ultrasound examination were compared with the pathological positive results.Receiver operating characteristic(ROC)curve was constructed,and area under curve(AUC)was calculated to evaluate the ultrasonic diagnostic efficiency of secondary intussusception due to focal PLP.The characteristics of sonogram are summarized.Results:1.There was no significant difference in the distribution of different age groups in the secondary intussusception group,but 76.5%of the patients were under 2 years old in the idiopathic intussusception group.The failure rate of air enema,intestinal necrosis rate and recurrence rate in the secondary intussusception group were 48.0%,10.8%and 45.9%,which were higher than 9.1%,2.2%and 11.2%in the idiopathic intussusception group respectively(P<0.05).2.Meckel’s diverticulum,intestinal polyps,intestinal duplication,lymphoma and Henoch-Schonlein purpura were the main PLP of secondary intussusception in children.The patients secondary to Meckel’s diverticulum and lymphomas were more common in males and secondary to intestinal polyps in females.56.3%of the patients secondary to Meckel’s diverticulum and 66.7%of the patients secondary to intestinal duplication were under 2 years old,and 53.8%of the patients secondary to intestinal polyps were 2 to 6 years old.The air enema failure rate and recurrence rate were 72.1%and 37.5%in the patients secondary to Meckel’s diverticulum,4.2%and 73.1%in intestinal polyps,50%and 33.3%in intestinal duplication,40.0%and 80.0%in lymphoma and 57.1%and 0.0%in Henoch-Schonlein purpura.3.The diameter,length and position of intussusception in the case group were different from those in the control group(P<0.05).76 cases of localized lesions were found in the two groups by ultrasonography,66 cases were confirmed by pathology,10 cases were misdiagnosed and 37 cases were missed.The sensitivity,specificity and AUC of ultrasound were 64.1%,97.8%and 0.809,respectively.In the abnormal sonogram,10 cases of thick-wall structure with blind end were confirmed by operation and pathology as Meckel’s diverticulum.Conclusion:1.It was prone to recurrence,air enema failure rate and intestinal necrosis rate were higher,and there was no significant difference in the distribution of different age groups in secondary intussusception.2.There are differences in clinical characteristics of intussusception secondary to different PLP.3.Ultrasonic examination of intussusception secondary to focal PLP had relatively high diagnostic value.